Legislation To Prevent Workplace Violence in Healthcare Awaits a Senate Vote

The latest data from the U.S. Bureau of Labor Statistics shows that 73% of all nonfatal workplace violence incidents involve healthcare workers. What’s more, this number only tells of reported cases. The fact is that many incidents go unreported or unnoticed.

Workplace violence against nurses and healthcare workers is a growing cause for concern. In fact, nurses are five times more likely to be injured by workplace violence than workers in other industries. 

Recent headlines of nurse killings have garnered attention. In September 2023, a nurse working in the psychiatric unit at Rhode Island Hospital was critically assaulted by a patient and placed in the ICU. In December 2022, Douglas Bryant, RN, was shot by a patient’s son during a home health visit. In October 2022, Nurse Katie Flowers and social worker Jacquline Pokuaa were killed on a Dallas, TX, hospital L&D floor. Only four days before that, psychiatric nurse practitioner June Onkundi was stabbed to death on the job by a patient.

The House of Representatives has passed legislation to curtail violence against nurses — twice. Still, H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, has yet to pass the Senate. This post explains what this legislation would do, why we need it, and where the support and opposition are coming from. We’ll also tell you where to find more information on this worker protection act for #safeworkers and #safecare.

What is the Workplace Violence Prevention Act?

H.R. 1195, also referred to as the Workplace Violence Prevention Act was introduced to the House of Representatives on February 22, 2021, by Democratic Representative Joe Courtney from Connecticut’s second district.

Congressman Courtney has a unique perspective on the growing crisis of on-the-job violence facing nurses. “I’ve been married to a nurse practitioner for over thirty years,” said Congressman Courtney. “Nurses didn’t join the profession to take abuse, and the best way to support them and to retain and recruit qualified health care professionals is to ensure they don’t have to worry about getting physically assaulted, or worse, at work. That’s what the Workplace Violence Prevention bill is all about.”

The U.S. Department of Labor Occupational Safety and Health Administration (OSHA) has issued guidance on how employers can prevent workplace violence against healthcare workers and social services. However, if enacted the Workplace Violence Prevention Act would hold employers more accountable. Read a section-by-section summary of the bill here. 

Workplace Violence in Healthcare Trends

 In 2016, a congressional report found the rate of violence against healthcare workers to be at least 12 times higher than in the overall workforce.

The report contained jarring accounts of workplace incidents reported by healthcare workers, including:

• A worker was knocked unconscious by a patient when starting intravenous therapy on them.

• A patient broke a healthcare worker’s hand when the worker intervened in a conflict between two patients.

• Another worker was attacked by a patient with dementia and had to defend themself.

• A worker was struck in the head by a patient while drawing blood and suffered a concussion and a permanent neck injury.

Current Bureau of Labor Statistics data shows that the problem has worsened. 

“Recent patient violence against staff at my hospital has led to nurses with broken jaws, open facial wounds, back injuries requiring surgery, and injuries from a chair being smashed over a nurse’s head,” said Judy Danella, a registered nurse and member of the United Steelworkers union at a hospital in New Jersey. “Injuries from combative patients shouldn’t just be part of the job.”

Representative Courtney and others have requested that OSHA establish a workplace safety standard to curb increasing violence. But OSHA has yet to act voluntarily. 

A statement on Congressman Courtney’s website says, “legislation is necessary to ensure that nurses, doctors, medical assistants, emergency personnel, and social service workers are not subjected to needless preventable acts of violence on the job.”

What Does the Act Do?

If signed into law, the Workplace Violence Prevention for Health Care and Social Service Workers Act would create new requirements for companies, organizations, and facilities that employ healthcare or social service workers. Under H.R. 1195, employers would be responsible for the following:

• Implementing a risk assessment and prevention plan

• Providing workplace prevention training for employees

• Investigating occurrences of workplace violence

Employers would be required to keep records of these workplace prevention activities for five years. OSHA would enforce compliance with the legislation through inspections.

Support for the Act

Professional organizations like the American Nurses Association (ANA) are backing the bill. “This bill is a step in the right direction to ensure that employers not only develop and implement plans to protect their staff, but that they also begin addressing existing barriers to reporting,” said Loressa Cole, DNP, MBA, R.N., NEA-BC, FACHE, and CEO of ANA said. “At the heart of this widespread epidemic are workplace cultures that discourage nurses from reporting for fear of retribution. A safe work environment that promotes physical and psychological well-being is essential to provide quality care and drive positive health outcomes for patients, families and communities.”

The nation’s largest teachers union, the American Federation of Teachers (AFT), has also spoken in support of this legislation. “We welcome this legislation as it outlines protections and safety standards for the people who care for the sick, treat the injured, and work in other front-line care jobs,” said Randi Weingarten, AFT President. “Millions in the healthcare profession go to work every day to care for the sick, the elderly and mentally ill, yet they don’t feel safe or protected...with this bill, we can change that.”

The country’s largest nurses union, National Nurses United (NNU), also supports the legislation. “Registered Nurses are often threatened, punched, kicked, beaten, and assaulted on the job, sometimes with deadly consequences,” said Jean Ross, RN, NNU Co-President. “Many incidents would be preventable if this legislation was enacted.” 

Other organizations who are endorsing H.R. 1195 include:

• American Federation of State, County and Municipal Employees

• American Federation of Labor and the Congress of Industrial Organizations

• Public Citizen

• American Federation of Government Employees

• International Association of Fire Fighters

• United Steelworkers

• AIHA American Industrial Hygiene Association

• Teamsters

• American Psychiatric Nurses Association

Opposition to the Act

A major voice expressing concern over H.R. 1195 has been the American Hospital Association (AHA). “We do not believe that the OSHA standards required by H.R. 1195 are warranted.”

In a letter to Congressman Courtney, the organization explained, “the prohibitive costs that the bill would impose on America’s hospitals, particularly those that provide care in rural and underserved areas, could strain scarce resources and jeopardize patient care. It went on to say that the legislation would “burden health care providers that are struggling to maintain services during the most deadly public health emergency in 100 years.”

Other members of Congress have expressed similar concerns. Education and Labor Committee Republican Leader Virginia Foxx of North Carolina suggested that this bill is “the wrong solution to a serious problem.”

She agreed with the AHA that the Workplace Violence Prevention Act would hurt workers and employers already overwhelmed in the healthcare and social service industries. The Congressional Budget Office estimates that H.R. 1195 will cost private organizations at least $1.8 billion in the first two years and $750 million annually after that. The cost to public facilities will be at least $100 million in the first two years, then $55 million annually. 

Struggling facilities cannot afford such an expensive government-imposed mandate. This is a real concern. According to the Center for Healthcare Quality and Payment Reform, there is a rural hospital closing crisis. Nearly 30% of rural hospitals are at risk of closing. The country’s rural communities support much of the country’s food supply, coal mining, gas and oil production, and wind and solar facilities. When rural communities fail, there is a widespread economic impact. 

“Our healthcare workers and caregivers deserve an evidenced-based and effective solution that protects them in the workplace. H.R. 1195 fails to deliver this result,” Foxx said. 

What’s Next for this Legislation

The act was introduced to the Senate during Nurses Week 2022. There it awaits a vote. If the Senate approves the Workplace Violence Prevention Act, it will go to the President’s desk for signature. Then, it would become law.

Where to Find More Information

To learn more about the Workplace Violence Prevention Act, check out the webpage at Congress.gov.